Pott’s spine,commonly known as spinal tuberculosis(TB),is an extrapulmonary form of TB caused by Mycobacterium TB.Pott’s paraplegia occurs when the spine is involved.Spinal TB is usually caused by the hematogenous s...Pott’s spine,commonly known as spinal tuberculosis(TB),is an extrapulmonary form of TB caused by Mycobacterium TB.Pott’s paraplegia occurs when the spine is involved.Spinal TB is usually caused by the hematogenous spread of infection from a central focus,which can be in the lungs or another location.Spinal TB is distinguished by intervertebral disc involvement caused by the same segmental arterial supply,which can result in severe morbidity even after years of approved therapy.Neurological impairments and spine deformities are caused by progressive damage to the anterior vertebral body.The clinical,radiographic,microbiological,and histological data are used to make the diagnosis of spinal TB.In Pott’s spine,combination multidrug antitubercular therapy is the basis of treatment.The recent appearance of multidrug-resistant/extremely drug-resistant TB and the growth of human immunodeficiency virus infection have presented significant challenges in the battle against TB infection.Patients who come with significant kyphosis or neurological impairments are the only ones who require surgical care.Debride-ment,fusion stabilization,and correction of spinal deformity are the cornerstones of surgical treatment.Clinical results for the treatment of spinal TB are generally quite good with adequate and prompt care.展开更多
Objective: In the present study, spinal metastatic tumors, brucellar spondylitis and spinal tuberculosis werequantitatively analyzed using dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) to assess th...Objective: In the present study, spinal metastatic tumors, brucellar spondylitis and spinal tuberculosis werequantitatively analyzed using dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) to assess thevalue of DCE-MRI in the differential diagnosis of these diseases.Methods: Patients with brucellar spondylitis, spinal tuberculosis or a spinal metastatic tumor (30 cases of each)received conventional MRI and DCE-MRI examination. The volume transfer constant (Ktrans), rate constant (Kep),extravascular extracellular volume fraction (Ve) and plasma volume fraction (Vp) of the diseased vertebral bodieswere measured on the perfusion parameter map, and the differences in these parameters between the patients werecompared.Results: For pathological vertebrae in cases of spinal metastatic tumor, brucellar spondylitis and spinaltuberculosis, respectively, the Ktrans values (median + quartile pitch) were 0.989±0.014, 0.720±0.011 and0.317±0.005 min-1; the Kep values were 2.898±0.055, 1.327±0.017 and 0.748±0.006 min-1; the Ve values were0.339±0.008, 0.542±0.013 and 0.428±0.018; the Vp values were 0.048±0.008, 0.035±0.004 and 0.028±0.009; thecorresponding H values were 50.25 (for Ktrans), 52.47 (for Kep), 48.33 (for Ve) and 46.56 (for Vp), and all differenceswere statistically significant (two-sided P〈0.05).Conclusions: The quantitative analysis of DCE-MRI has a certain value in the differential diagnosis of spinalmetastatic tumor, brucellar spondylitis and spinal tuberculosis.展开更多
This study examined the clinical outcomes of one-stage surgical treatment for patients with spinal tuberculosis via a posterior-only approach. Twenty-four patients with thoracic or lumbar spinal tuberculosis whose les...This study examined the clinical outcomes of one-stage surgical treatment for patients with spinal tuberculosis via a posterior-only approach. Twenty-four patients with thoracic or lumbar spinal tuberculosis whose lesions were confined to adjacent segments were admitted to our hospital and treated. The American Spinal Injury Association(ASIA) impairment scale was used to assess the neurological function. All patients were treated with one-stage surgical treatment via a posterior-only approach. The clinical efficacy was evaluated by the Japanese Orthopaedic Association(JOA) scores and oswestry disability index(ODI) of nerve function. Patients were evaluated preoperatively and postoperatively by measurement of spinal deformity using Cobb angle and radiological examination. All the patients were followed up for 13 to 27 months. They had significantly postoperative improvement in JOA score, ODI and ASIA classification scores. The kyphotic angles were significantly corrected and maintained at the final follow-up. Bone fusion was achieved within 4–12 months. It was concluded that one-stage surgical treatment via a posterior-only approach is effective and feasible for the treatment of spinal tuberculosis.展开更多
BACKGROUND: Spinal tuberculosis is a common disease in orthopedic clinical practice; however, it is seldom reported after organ transplantation. The aim of this study was to investigate the diagnosis and treatment of ...BACKGROUND: Spinal tuberculosis is a common disease in orthopedic clinical practice; however, it is seldom reported after organ transplantation. The aim of this study was to investigate the diagnosis and treatment of spinal tuberculosis after organ transplantation. METHOD: Two cases were diagnosed as spinal tuberculosis after liver transplantation and were treated with socarboxazide, rifampicin, streptomycin and ethambutol for more than one year. RESULTS: After treatment with anti-tuberculosis drugs for several months, the symptoms of both patients clearly improved. Back pain disappeared, and erythrocyte sedimentation and body temperature returned to normal. CONCLUSIONS: We should highly suspect spinal tuberculosis if notalgia and night sweats are present after organ transplantation. Anti-tuberculosis therapy is an effective treatment for spinal tuberculosis after organ transplantation.展开更多
Objective: To evaluate the clinical feasibility and efficacy in treatment of thoracic tuberculosis via paraspinal approach. Methods: From June 2011 to August 2016, 24 patients with mono-segmental thoracic spine tuberc...Objective: To evaluate the clinical feasibility and efficacy in treatment of thoracic tuberculosis via paraspinal approach. Methods: From June 2011 to August 2016, 24 patients with mono-segmental thoracic spine tuberculosis were treated by transfacet debridement combined with bone grafting and internal fixation through paraspinal approach. There were 11 males and 13 females with age ranging from 21 to 63 years (average, 39.5). There were 3 patients in T4/5, 2 patients in T5/6, 3 patients in T7/8, 3 patients in T8/9, 4 patients in T9/10, 3 patients in T10/11, and 6 patients in T11/12. Patients had different degraded local kyphosis deformity shown on X-ray, and different degraded bone destruction and abscess in thoracic spine shown on CT and MRI before the operation. All of the patients before the regular anti tuberculosis treatment for 2 to 4 weeks, the surgical approach used by paraspinal muscle approach, postoperative regular anti tuberculosis treatment for 9 to 12 weeks. Record the clinical symptoms of patients before and after surgery, preoperative Frankel functional classification of spinal cord injury, the operative time, intraoperative blood loss, postoperative ESR, CRP, complications, VAS score, ODI score and Cobb angle changes, imaging check regularly to evaluate the fusion and follow-up of nerve functional recovery. Results: The average operation time was 198 min. The average blood loss was 436 ml. There were no severe complications during and after operation. All patients were followed up for 1 year to 2 years, average 1.5 years of follow-up, the clinical symptoms improved significantly after operation and last follow-up ESR, CRP, VAS score, ODI score and Cobb angle were significantly improved after operation (P < 0.05), grade I Eck fusion, the fusion rate was 100% and the neurological function were improved. Conclusion: on the basis of strict anti tuberculosis chemotherapy, the use of paraspinal muscle gap approach for the treatment of thoracic tuberculosis is less invasive, less destructive to spinal stability, and can achieve obvious curative effect. It is worthy of clinical application.展开更多
Spinal tuberculosis,as one of the most serious forms of extrapulmonary tuberculosis,is one of the primary causes of spinal deformity and paralysis in developing countries.It immensely affects people's quality of l...Spinal tuberculosis,as one of the most serious forms of extrapulmonary tuberculosis,is one of the primary causes of spinal deformity and paralysis in developing countries.It immensely affects people's quality of life with high incidences of deformity and disability.The onset of spinal tuberculosis is related to many factors such as gender,age,environment,habits and hereditary factor.As a genetic factor,gene polymorphism plays an important role in the occurrence and development of tuberculosis.This article reviews the research progress of the susceptibility of spinal tuberculosis and its related gene polymorphisms,in order to provide reference for early prevention and treatment of spinal tuberculosis.展开更多
Objective:To investigate the effect of intensive psycho1ogical nursing on the mood and coping ways of spinal tuberculosis patients.Methods:The clinical data of 102 patients undergoing spinal tuberculosis surgery in ou...Objective:To investigate the effect of intensive psycho1ogical nursing on the mood and coping ways of spinal tuberculosis patients.Methods:The clinical data of 102 patients undergoing spinal tuberculosis surgery in our hospital from February 2017 to January 2020 were retrospectively analyzed.A11 the cases were grouped according to different nursing plans,patients who received routine care were included in the control group(n=50),and the ones with intensive psychological care were included in the observation group(n=52).Compare negative emotions after nursing[assessment using self-assessment scale of anxiety(SAS),depression self-assessment scale(SDS)]and solutions[assessment using medical response questionnaire(MCMQ)]of the two groups.Results:After nursing,the SAs,SDs scores,avoidance and yield scores of the two groups were reduced,and the coping scores were increased,and the change of the observation group was greater than that of the control group,the difference was statistically significant(P<0.05).Conclusion:Spinal tuberculosis surgery patients were treated with intensive psychological care,which can relieve patients'negative emotions,improve solutions and are worthy of clinical use.展开更多
Dear Editor,I am Dr.Tian-Wei Qian,from Shanghai General Hospital,Shanghai,China.I write to present one case report of tuberculosis(TB)-associated uveitis after corticosteroid treatment for Vogt-Koyanagi-Harada(VKH...Dear Editor,I am Dr.Tian-Wei Qian,from Shanghai General Hospital,Shanghai,China.I write to present one case report of tuberculosis(TB)-associated uveitis after corticosteroid treatment for Vogt-Koyanagi-Harada(VKH)disease.展开更多
Objective To discuss perioperative features,operative approach and surgical effects of spinal tuberculosis in older patients.Methods Retrospective analysis was conducted to analyze the clinical data of 45 patients wit...Objective To discuss perioperative features,operative approach and surgical effects of spinal tuberculosis in older patients.Methods Retrospective analysis was conducted to analyze the clinical data of 45 patients with spinal展开更多
Introduction: The occurrence of tuberculosis (TB) during the follow-up of Connective tissue diseases (CTD) is a particular situation often posing real diagnostic problems. This is an association described in the liter...Introduction: The occurrence of tuberculosis (TB) during the follow-up of Connective tissue diseases (CTD) is a particular situation often posing real diagnostic problems. This is an association described in the literature. Patients and methods: We conducted a retrospective and descriptive study at the internal medicine department of Aristide Le Dantec Hospital. The purpose of this study was to determine the treatment that patients followed for CTD and suffering from TB took before the occurrence of this one. Results: During a study period of 11 years and 6 months, 21 cases of TB were diagnosed in 602 cases of CTD (0.03%). The predominance was female with a sex ratio (H/F) of 0.6. The median age was 42 years old. The majority of cases originated from the Dakar region (13 patients or 61.9%) and 85.7% had previous follow-up exclusively in modern medicine and 21 cases (95%) received the CTD’s treatment. This consisted of prednisone (90.5%) combined with methotrexate (52.4%), azathioprine (23.8%) or cyclophosphamide (19.4%). The respective medians doses of these drugs were 12.5 mg per day for prednisone, 13.5 mg per week for methotrexate and 100 mg per day for azathioprine. The median duration of patient follow-up was 36 months. The cumulative dose of prednisone during this period was 23.6 g and that of methotrexate 2.25 g. CTD were dominated by rheumatoid arthritis (RA) (57.1%), and systemic lupus (19%). Isolated cases of systemic scleroderma, primary Sjôgren, SHARP syndrom, mixed connective tissue disease, and multiple autoimmune syndrom were noted. TB was localized in 95% of cases, readily bilateral and poorly disseminated. The respective medians diagnostic delays for systemic disease and TB were 21 months and 5 months. Tuberculin intradermal reaction was performed in 16 cases and was positive in 9 cases, sputum bacilli was performed in 19 cases and was positive in 15 cases. Conclusion: The association of TB and CTD was characterized by its rarity, its poorly disseminated character and its frequency on RA field.展开更多
<b style="line-height:1.5;"><span style="font-family:Verdana;">Objective:</span></b><span style="font-family:'';line-height:1.5;"><span style=&quo...<b style="line-height:1.5;"><span style="font-family:Verdana;">Objective:</span></b><span style="font-family:'';line-height:1.5;"><span style="font-family:Verdana;"> To evaluate the prevalence of spinal infection in a hospital located in the eastern region of Saudi Arabia through a retrospective review and to identify the associated etiological agents in terms of clinical picture, treatment, and outcomes. </span><b><span style="font-family:Verdana;">Design: </span></b><span style="font-family:Verdana;">Retrospective cross-sectional study. </span><b><span style="font-family:Verdana;">Setting:</span></b><span style="font-family:Verdana;"> Single hospital in Dhahran, Saudi Arabia. </span><b><span style="font-family:Verdana;">Patients:</span></b><span style="font-family:Verdana;"> Patients with any type of spinal infection and/or who had undergone neurosurgical intervention for spinal infection between January 2006 and December 2018. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> We collected data on all patients with an established diagnosis of spinal infection from January 2006 to December 2018 in the King Fahad Military Medical Complex in Dhahran, Saudi Arabia. A validated and structured checklist was used for data collection. Spinal infection diagnosis was based on the clinical manifestation, microbiological evidence, radiological findings, and antimicrobial therapy response. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> Seventeen patients were included in this study, and their mean age was 54.93 years. Twelve of the patients were male and four were female. The approximate time from symptom onset to diagnosis was 2</span></span><span style="line-height:1.5;font-family:Verdana;"> - </span><span style="line-height:1.5;font-family:Verdana;">6 months. Most of the patients experienced back pain, with lumbosacral spondylitis being the most commonly cited type (61.11%), followed </span><span style="line-height:1.5;font-family:Verdana;">by thoracolumbar spondylodiscitis (25%) and cervical spondylodiscitis (6.25%). The most frequently isolated organism was </span><i style="font-family:'';line-height:1.5;"><span style="font-family:Verdana;">Mycobacterium tuberculosis</span></i><span style="line-height:1.5;font-family:Verdana;"> (8 patients, 50%), followed by extended-spectrum beta lactamase (ESBL)-producing </span><i style="font-family:'';line-height:1.5;"><span style="font-family:Verdana;">Escherichia coli</span></i><span style="line-height:1.5;font-family:Verdana;"> (4 patients, 25%), </span><i style="font-family:'';line-height:1.5;"><span style="font-family:Verdana;">Brucella</span></i><span style="line-height:1.5;font-family:Verdana;"> spp (3 patients, 18.75%), </span><i style="font-family:'';line-height:1.5;"><span style="font-family:Verdana;">Staphylococcus aureus</span></i><span style="line-height:1.5;font-family:Verdana;"> (1 patient, 6.25%), and </span><i style="font-family:'';line-height:1.5;"><span style="font-family:Verdana;">Quambalaria cyanescens</span></i><span style="line-height:1.5;font-family:Verdana;"> (1 patient, 6.25%). Totally, in 50% of the patients with thoracolumbar and lumbosacra site involvement, tuberculosis spondylodiscitis was observed, while another 50% of the cases showed complications associated with paravertebral abscess that required surgical drainage. </span><b style="font-family:'';line-height:1.5;"><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:'';line-height:1.5;"> </span><i style="font-family:'';line-height:1.5;"><span style="font-family:Verdana;">M. tuberculosis</span></i><span style="line-height:1.5;font-family:Verdana;"> was found to be the major cause of infectious spondylodiscitis. Additionally, </span><i style="font-family:'';line-height:1.5;"><span style="font-family:Verdana;">Quambalaria cyanescens</span></i><span style="line-height:1.5;font-family:Verdana;"> was isolated;this is the second reported case of the organism being isolated and the first associated with spinal infection.展开更多
文摘Pott’s spine,commonly known as spinal tuberculosis(TB),is an extrapulmonary form of TB caused by Mycobacterium TB.Pott’s paraplegia occurs when the spine is involved.Spinal TB is usually caused by the hematogenous spread of infection from a central focus,which can be in the lungs or another location.Spinal TB is distinguished by intervertebral disc involvement caused by the same segmental arterial supply,which can result in severe morbidity even after years of approved therapy.Neurological impairments and spine deformities are caused by progressive damage to the anterior vertebral body.The clinical,radiographic,microbiological,and histological data are used to make the diagnosis of spinal TB.In Pott’s spine,combination multidrug antitubercular therapy is the basis of treatment.The recent appearance of multidrug-resistant/extremely drug-resistant TB and the growth of human immunodeficiency virus infection have presented significant challenges in the battle against TB infection.Patients who come with significant kyphosis or neurological impairments are the only ones who require surgical care.Debride-ment,fusion stabilization,and correction of spinal deformity are the cornerstones of surgical treatment.Clinical results for the treatment of spinal TB are generally quite good with adequate and prompt care.
基金funded by the National Natural Science Foundation of China (No. 81460259)
文摘Objective: In the present study, spinal metastatic tumors, brucellar spondylitis and spinal tuberculosis werequantitatively analyzed using dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) to assess thevalue of DCE-MRI in the differential diagnosis of these diseases.Methods: Patients with brucellar spondylitis, spinal tuberculosis or a spinal metastatic tumor (30 cases of each)received conventional MRI and DCE-MRI examination. The volume transfer constant (Ktrans), rate constant (Kep),extravascular extracellular volume fraction (Ve) and plasma volume fraction (Vp) of the diseased vertebral bodieswere measured on the perfusion parameter map, and the differences in these parameters between the patients werecompared.Results: For pathological vertebrae in cases of spinal metastatic tumor, brucellar spondylitis and spinaltuberculosis, respectively, the Ktrans values (median + quartile pitch) were 0.989±0.014, 0.720±0.011 and0.317±0.005 min-1; the Kep values were 2.898±0.055, 1.327±0.017 and 0.748±0.006 min-1; the Ve values were0.339±0.008, 0.542±0.013 and 0.428±0.018; the Vp values were 0.048±0.008, 0.035±0.004 and 0.028±0.009; thecorresponding H values were 50.25 (for Ktrans), 52.47 (for Kep), 48.33 (for Ve) and 46.56 (for Vp), and all differenceswere statistically significant (two-sided P〈0.05).Conclusions: The quantitative analysis of DCE-MRI has a certain value in the differential diagnosis of spinalmetastatic tumor, brucellar spondylitis and spinal tuberculosis.
文摘This study examined the clinical outcomes of one-stage surgical treatment for patients with spinal tuberculosis via a posterior-only approach. Twenty-four patients with thoracic or lumbar spinal tuberculosis whose lesions were confined to adjacent segments were admitted to our hospital and treated. The American Spinal Injury Association(ASIA) impairment scale was used to assess the neurological function. All patients were treated with one-stage surgical treatment via a posterior-only approach. The clinical efficacy was evaluated by the Japanese Orthopaedic Association(JOA) scores and oswestry disability index(ODI) of nerve function. Patients were evaluated preoperatively and postoperatively by measurement of spinal deformity using Cobb angle and radiological examination. All the patients were followed up for 13 to 27 months. They had significantly postoperative improvement in JOA score, ODI and ASIA classification scores. The kyphotic angles were significantly corrected and maintained at the final follow-up. Bone fusion was achieved within 4–12 months. It was concluded that one-stage surgical treatment via a posterior-only approach is effective and feasible for the treatment of spinal tuberculosis.
文摘BACKGROUND: Spinal tuberculosis is a common disease in orthopedic clinical practice; however, it is seldom reported after organ transplantation. The aim of this study was to investigate the diagnosis and treatment of spinal tuberculosis after organ transplantation. METHOD: Two cases were diagnosed as spinal tuberculosis after liver transplantation and were treated with socarboxazide, rifampicin, streptomycin and ethambutol for more than one year. RESULTS: After treatment with anti-tuberculosis drugs for several months, the symptoms of both patients clearly improved. Back pain disappeared, and erythrocyte sedimentation and body temperature returned to normal. CONCLUSIONS: We should highly suspect spinal tuberculosis if notalgia and night sweats are present after organ transplantation. Anti-tuberculosis therapy is an effective treatment for spinal tuberculosis after organ transplantation.
文摘Objective: To evaluate the clinical feasibility and efficacy in treatment of thoracic tuberculosis via paraspinal approach. Methods: From June 2011 to August 2016, 24 patients with mono-segmental thoracic spine tuberculosis were treated by transfacet debridement combined with bone grafting and internal fixation through paraspinal approach. There were 11 males and 13 females with age ranging from 21 to 63 years (average, 39.5). There were 3 patients in T4/5, 2 patients in T5/6, 3 patients in T7/8, 3 patients in T8/9, 4 patients in T9/10, 3 patients in T10/11, and 6 patients in T11/12. Patients had different degraded local kyphosis deformity shown on X-ray, and different degraded bone destruction and abscess in thoracic spine shown on CT and MRI before the operation. All of the patients before the regular anti tuberculosis treatment for 2 to 4 weeks, the surgical approach used by paraspinal muscle approach, postoperative regular anti tuberculosis treatment for 9 to 12 weeks. Record the clinical symptoms of patients before and after surgery, preoperative Frankel functional classification of spinal cord injury, the operative time, intraoperative blood loss, postoperative ESR, CRP, complications, VAS score, ODI score and Cobb angle changes, imaging check regularly to evaluate the fusion and follow-up of nerve functional recovery. Results: The average operation time was 198 min. The average blood loss was 436 ml. There were no severe complications during and after operation. All patients were followed up for 1 year to 2 years, average 1.5 years of follow-up, the clinical symptoms improved significantly after operation and last follow-up ESR, CRP, VAS score, ODI score and Cobb angle were significantly improved after operation (P < 0.05), grade I Eck fusion, the fusion rate was 100% and the neurological function were improved. Conclusion: on the basis of strict anti tuberculosis chemotherapy, the use of paraspinal muscle gap approach for the treatment of thoracic tuberculosis is less invasive, less destructive to spinal stability, and can achieve obvious curative effect. It is worthy of clinical application.
基金Fund Project:Traditional Chinese Medicine Research Project of Hubei Provincial Health Commission(ZY2019F025)the Clinical Research Supported by Wu Jieping Medical Foundation(No.320.6750.17566)。
文摘Spinal tuberculosis,as one of the most serious forms of extrapulmonary tuberculosis,is one of the primary causes of spinal deformity and paralysis in developing countries.It immensely affects people's quality of life with high incidences of deformity and disability.The onset of spinal tuberculosis is related to many factors such as gender,age,environment,habits and hereditary factor.As a genetic factor,gene polymorphism plays an important role in the occurrence and development of tuberculosis.This article reviews the research progress of the susceptibility of spinal tuberculosis and its related gene polymorphisms,in order to provide reference for early prevention and treatment of spinal tuberculosis.
文摘Objective:To investigate the effect of intensive psycho1ogical nursing on the mood and coping ways of spinal tuberculosis patients.Methods:The clinical data of 102 patients undergoing spinal tuberculosis surgery in our hospital from February 2017 to January 2020 were retrospectively analyzed.A11 the cases were grouped according to different nursing plans,patients who received routine care were included in the control group(n=50),and the ones with intensive psychological care were included in the observation group(n=52).Compare negative emotions after nursing[assessment using self-assessment scale of anxiety(SAS),depression self-assessment scale(SDS)]and solutions[assessment using medical response questionnaire(MCMQ)]of the two groups.Results:After nursing,the SAs,SDs scores,avoidance and yield scores of the two groups were reduced,and the coping scores were increased,and the change of the observation group was greater than that of the control group,the difference was statistically significant(P<0.05).Conclusion:Spinal tuberculosis surgery patients were treated with intensive psychological care,which can relieve patients'negative emotions,improve solutions and are worthy of clinical use.
文摘Dear Editor,I am Dr.Tian-Wei Qian,from Shanghai General Hospital,Shanghai,China.I write to present one case report of tuberculosis(TB)-associated uveitis after corticosteroid treatment for Vogt-Koyanagi-Harada(VKH)disease.
文摘Objective To discuss perioperative features,operative approach and surgical effects of spinal tuberculosis in older patients.Methods Retrospective analysis was conducted to analyze the clinical data of 45 patients with spinal
文摘Introduction: The occurrence of tuberculosis (TB) during the follow-up of Connective tissue diseases (CTD) is a particular situation often posing real diagnostic problems. This is an association described in the literature. Patients and methods: We conducted a retrospective and descriptive study at the internal medicine department of Aristide Le Dantec Hospital. The purpose of this study was to determine the treatment that patients followed for CTD and suffering from TB took before the occurrence of this one. Results: During a study period of 11 years and 6 months, 21 cases of TB were diagnosed in 602 cases of CTD (0.03%). The predominance was female with a sex ratio (H/F) of 0.6. The median age was 42 years old. The majority of cases originated from the Dakar region (13 patients or 61.9%) and 85.7% had previous follow-up exclusively in modern medicine and 21 cases (95%) received the CTD’s treatment. This consisted of prednisone (90.5%) combined with methotrexate (52.4%), azathioprine (23.8%) or cyclophosphamide (19.4%). The respective medians doses of these drugs were 12.5 mg per day for prednisone, 13.5 mg per week for methotrexate and 100 mg per day for azathioprine. The median duration of patient follow-up was 36 months. The cumulative dose of prednisone during this period was 23.6 g and that of methotrexate 2.25 g. CTD were dominated by rheumatoid arthritis (RA) (57.1%), and systemic lupus (19%). Isolated cases of systemic scleroderma, primary Sjôgren, SHARP syndrom, mixed connective tissue disease, and multiple autoimmune syndrom were noted. TB was localized in 95% of cases, readily bilateral and poorly disseminated. The respective medians diagnostic delays for systemic disease and TB were 21 months and 5 months. Tuberculin intradermal reaction was performed in 16 cases and was positive in 9 cases, sputum bacilli was performed in 19 cases and was positive in 15 cases. Conclusion: The association of TB and CTD was characterized by its rarity, its poorly disseminated character and its frequency on RA field.
文摘<b style="line-height:1.5;"><span style="font-family:Verdana;">Objective:</span></b><span style="font-family:'';line-height:1.5;"><span style="font-family:Verdana;"> To evaluate the prevalence of spinal infection in a hospital located in the eastern region of Saudi Arabia through a retrospective review and to identify the associated etiological agents in terms of clinical picture, treatment, and outcomes. </span><b><span style="font-family:Verdana;">Design: </span></b><span style="font-family:Verdana;">Retrospective cross-sectional study. </span><b><span style="font-family:Verdana;">Setting:</span></b><span style="font-family:Verdana;"> Single hospital in Dhahran, Saudi Arabia. </span><b><span style="font-family:Verdana;">Patients:</span></b><span style="font-family:Verdana;"> Patients with any type of spinal infection and/or who had undergone neurosurgical intervention for spinal infection between January 2006 and December 2018. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> We collected data on all patients with an established diagnosis of spinal infection from January 2006 to December 2018 in the King Fahad Military Medical Complex in Dhahran, Saudi Arabia. A validated and structured checklist was used for data collection. Spinal infection diagnosis was based on the clinical manifestation, microbiological evidence, radiological findings, and antimicrobial therapy response. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> Seventeen patients were included in this study, and their mean age was 54.93 years. Twelve of the patients were male and four were female. The approximate time from symptom onset to diagnosis was 2</span></span><span style="line-height:1.5;font-family:Verdana;"> - </span><span style="line-height:1.5;font-family:Verdana;">6 months. Most of the patients experienced back pain, with lumbosacral spondylitis being the most commonly cited type (61.11%), followed </span><span style="line-height:1.5;font-family:Verdana;">by thoracolumbar spondylodiscitis (25%) and cervical spondylodiscitis (6.25%). The most frequently isolated organism was </span><i style="font-family:'';line-height:1.5;"><span style="font-family:Verdana;">Mycobacterium tuberculosis</span></i><span style="line-height:1.5;font-family:Verdana;"> (8 patients, 50%), followed by extended-spectrum beta lactamase (ESBL)-producing </span><i style="font-family:'';line-height:1.5;"><span style="font-family:Verdana;">Escherichia coli</span></i><span style="line-height:1.5;font-family:Verdana;"> (4 patients, 25%), </span><i style="font-family:'';line-height:1.5;"><span style="font-family:Verdana;">Brucella</span></i><span style="line-height:1.5;font-family:Verdana;"> spp (3 patients, 18.75%), </span><i style="font-family:'';line-height:1.5;"><span style="font-family:Verdana;">Staphylococcus aureus</span></i><span style="line-height:1.5;font-family:Verdana;"> (1 patient, 6.25%), and </span><i style="font-family:'';line-height:1.5;"><span style="font-family:Verdana;">Quambalaria cyanescens</span></i><span style="line-height:1.5;font-family:Verdana;"> (1 patient, 6.25%). Totally, in 50% of the patients with thoracolumbar and lumbosacra site involvement, tuberculosis spondylodiscitis was observed, while another 50% of the cases showed complications associated with paravertebral abscess that required surgical drainage. </span><b style="font-family:'';line-height:1.5;"><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:'';line-height:1.5;"> </span><i style="font-family:'';line-height:1.5;"><span style="font-family:Verdana;">M. tuberculosis</span></i><span style="line-height:1.5;font-family:Verdana;"> was found to be the major cause of infectious spondylodiscitis. Additionally, </span><i style="font-family:'';line-height:1.5;"><span style="font-family:Verdana;">Quambalaria cyanescens</span></i><span style="line-height:1.5;font-family:Verdana;"> was isolated;this is the second reported case of the organism being isolated and the first associated with spinal infection.